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Advances in Head-and-Neck Interventional Radiotherapy (Brachytherapy)

Luca Tagliaferri ; Bruno Fionda ; Warren Bacorro ; Gyö ; rgy Kovacs

Journal of Medicine University of Santo Tomas.2024;8(1):1338-1341. doi:10.35460/2546-1621.2023-0122

Interventional radiotherapy, also known as brachytherapy, is the use of sealed radioactive sources that directly deliver radiation to the tumor or tumor bed. Its unique dose distribution profile allows for high conformality, making it a very useful modality in the treatment of cancers in the head and neck, where different organs and substructures that serve various but related functions are situated close to each other. In recent years, we have seen several important technological breakthroughs in the field, especially regarding its application in head and neck cancers. These include advances in treatment delivery, dosimetry planning , image guidance , and catheter positioning techniques . These innovations, which often require interdisciplinary interventions, have resulted in enhanced treatment accuracy, and therefore, major clinical advantages in terms of increased local control and decreased toxicity, as well as economic benefits. In order to highlight the differences from old brachytherapy techniques, a more appropriate terminology should perhaps be adopted, to signify these advancements that resulted in new opportunities, approaches and better outcomes – interventional radiotherapy (IRT). Such a change in terminology will not only allow recognition of these advances, but also a meaningful distinction from obsolete techniques and suboptimal outcomes that are associated with traditional brachytherapy. This is very important in increasing awareness among professionals outside the field of radiation oncology. We briefly review these recent advances, the current indications, and future directions for IRT in head-and-neck cancers.
Brachytherapy

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Interrater reliability of performing a step-by-step procedure for selected pain provocation tests for hamstrings and special tests for other lower extremity musculoskeletal injuries

Reil Vinard S. Espino ; Consuelo G. Suarez ; Lewis Ingram ; Ivan Neil B. Gomez ; Donald G. Manlapaz ; Vergel B. Orpilla ; Jazzmine Gale S. Flores ; Elaine Nicole S. Bulseco

Journal of Medicine University of Santo Tomas.2024;8(1):1342-1353. doi:10.35460/2546-1621.2023-0078

Objective: Our study aims to establish interrater reliability in performing the step-by-step procedure of selected pain provocation tests for hamstrings and special tests for lower extremity musculoskeletal injuries. Study Design: An interrater reliability study Setting: University of Santo Tomas - Sports Science Laboratory Participants: Ten healthy adults (five females, five males; age = 22.2 ± 0.42) from the university community. Main outcome measures: Interrater reliability of performing step-by-step procedures for selected pain provocation tests for hamstrings (painful resisted knee flexion 90°, painful resisted knee flexion 30°, active slump test, Puranen-Orava Test, bent knee stretch) and special tests for lower extremity musculoskeletal injuries (Lachman’s test, McMurray’s test, posterior drawer test, valgus, and varus stress test). Results: Fleiss kappa showed perfect agreement (κ = 1.00) for all test procedures except for Lachman’s test procedure 1 (κ= -0.11 [95% CI, -0.36 to 0.14]), active slump test procedure 4 (κ= -0.03 [95% CI, -0.28 to 0.23]), active slump test procedure 5 (κ= -0.11 [95% CI, -0.28 to 0.23]), and active slump test procedure 6 (κ= -0.05 [95% CI, -0.31 to 0.20]), which resulted in negative agreements. Conclusions The researcher developed protocols for each special and provocative test were consistent in measuring the intended procedures, and the raters were generally consistent with their ability to measure these tests.

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The effect of telemedicine on self-care activities of patients with Type 2 Diabetes Mellitus and patient satisfaction during the Coronavirus-19 (COVID-19) pandemic: A repeated cross-sectional study

Dionise Ysabelle V. Bawal ; Elaine C. Cunanan ; Sjoberg A. Kho

Journal of Medicine University of Santo Tomas.2024;8(1):1354-1361. doi:10.35460/2546-1621.2023-0066

Introduction: Patients with diabetes require regular follow-ups to achieve optimal glycemic targets. The coronavirus- 19 (COVID-19) pandemic resulted in interruptions in healthcare delivery placing greater importance on patient’s self-management of their condition. Telemedicine bridged the gap between the physician and patient that was created by community quarantines. Objective: To determine if there is a difference in patient’s self-care activities before and after using telemedicine using the Diabetes Self-Management Questionnaire (DSMQ). Methodology: A descriptive repeated cross-sectional study of patients with type 2 diabetes mellitus at the University of Santo Tomas Hospital who consulted via telemedicine using different available platforms were included. Self-care was measured using the DSMQ. Patient satisfaction with telemedicine was also assessed using a patient satisfaction survey. Results: An improvement in self-care practices was seen as significantly higher mean DSMQ scores after telemedicine consultations (6.79 ± 1.33 to 7.32 ± 1.21, p = 0.0015), with the highest scores on dietary control and physical activity. There was a statistically significant reduction in HbA1c on follow up (8.37 ± 2.31 to 7.31 ± 1.36; p<0.00001). Those with well-controlled diabetes (n = 14) at baseline remained to have good control while the proportion of those with poorly controlled diabetes (n = 34) showed improved glycemic control on follow up (p = 0.0045). Most patients were highly satisfied with telemedicine. Conclusion The use of telemedicine by patients with diabetes showed numerical improvement in both self-care practices and glycemic control. These findings imply that telemedicine may be mainstreamed as part of diabetes care among Filipinos.
COVID-19 ; Telemedicine

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Preferences of Medical Technology Students on COVID-19 Personal preventive behaviors and university safety protocols: A conjoint analysis

Ma. Camille Andrea Urbano ; Ria Anne Arellano ; Shanandra Rose Dizon ; Nicole Dominique Foja ; Jonas Galgana ; Lyka Gabrielle Terrado ; Paula Nadine Tuazon ; Florence Navidad

Journal of Medicine University of Santo Tomas.2024;8(1):1362-1370. doi:10.35460/2546-1621.2023-0072

The increase in coronavirus disease (COVID-19) cases in the Philippines has created an alarming issue in high-density public places, such as schools and universities. Personal preventive behaviors that the students exercise play a big part in whether such behaviors prevent or only predispose them even more to contracting the virus. Several factors may influence the personal preventive behaviors of an individual. These include attitude, awareness, personal beliefs, and culture concerning the disease. Through outlining these several factors, the researchers aim to identify the main attributes that determine students’ preferred COVID-19 personal preventive behavior and implemented precautionary measures. The researchers used a two-part survey: socioeconomic and demographic followed by an orthogonal plan. The safety protocols implemented by the university were found to be the most important factor, followed by knowledge about the disease, communication channels, attitude, and social construct of the family. Thus, this follows that based on the attribute’s importance value, the students prefer safety protocols that are most implemented by the university while social construct of the family is the least preferred. These findings suggest that the safety protocols implemented by the university are the most important factor, hence, policy implementation and strengthening should be observed by the university.
COVID-19 ; Knowledge ; Perception ; Attitude

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Cerebral venous sinus thrombosis presenting as intracerebral hemorrhage and subarachnoid hemorrhage: A case report

Francis Gideon C. Chen ; Joselito B. Diaz

Journal of Medicine University of Santo Tomas.2024;8(1):1371-1376. doi:10.35460/2546-1621.2023-0093

We present a 66-year-old male presenting with sudden onset of headache. Medical decompression was done and neuroimaging of plain cranial CT angiogram (CTA) and CT venogram (CTV) showed components of subarachnoid hemorrhage, intracerebral hemorrhage and hyperdense appearance of the superior sagittal sinus and proximal left transverse sinus. The following were done to look for etiologic factors: 1. fungal swab to determine the cause of the intracerebral hemorrhage secondary to venous thrombosis as the patient presented with a chronic history of sinusitis, 2. coagulopathy workup to look for a hypercoagulable state, and 3. workup for systemic disease of autoimmune in etiology. Anticoagulation was safely initiated within several days given the regression of the intracerebral hemorrhage along with stable findings of subarachnoid hemorrhage. Here we report cerebral venous sinus thrombosis rarely presenting as acute subarachnoid hemorrhage and intracerebral hemorrhage.
Subarachnoid Hemorrhage ; Cerebral Hemorrhage

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Teachable moments in ECG: The physiology behind the pattern

Marcellus Francis L. Ramirez

Journal of Medicine University of Santo Tomas.2024;8(1):1377-1380. doi:10.35460/2546-1621.2023-0102

The electrocardiographic analysis of heart blocks provides great opportunities for the discussion of mechanisms of electrical cardiac conduction, serving as “teachable moments” in medicine. Recognition of heart blocks can sometimes be a challenge as they can present in many forms, different severities and levels of blocks that present as varied patterns on electrocardiographic tracing. The ultimate key to correct diagnosis rests on adequate understanding of normal electrophysiology of the electrical system of the heart. While it is vital to recognize the pattern, we should always know and understand the physiology behind the pattern. This article presents a detailed analysis of a case of heart block which can easily be misinterpreted on first look. The case is featured not for its rarity but for the interesting concepts in cardiac electrophysiology that are highlighted. Navigation of the different elements of tracing can be an adventure and a great learning experience enjoyed by both students and experts.
Heart Block ; Electrocardiography

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Interdisciplinary and regional cooperation towards Head and Neck Cancer Interventional Radiotherapy (Brachytherapy) implementation in Southeast Asia

Vito Filbert Jayalie ; David Johnson ; Sudibio Sudibio ; Rudiyo Rudiyo ; Juli Jamnasi ; Hendriyo Hendriyo ; Jose Roel Resubal ; Dan Joseph Manlapaz ; Marjorie Cua ; Janell Marie Genson ; Cesar Vincent Villafuerte III ; Jennifer Alzaga ; Evelyn Dancel ; Stellar Marie Cabrera ; Maureen Bojador ; Ashwini Budrukkar ; Michael Benedict Mejia ; Adrian Fernando ; Warren Bacorro

Journal of Medicine University of Santo Tomas.2024;8(1):1381-1389. doi:10.35460/2546-1621.2024-0003

We review the evolution of Brachytherapy to interventional radiotherapy and its current and potential roles in HNC management, and the requirements and challenges towards its effective and sustainable implementation in SEA.
Brachytherapy ; Radiotherapy

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Systemic Hormonal Unloading (SHU) in secondary hypertension: Addressing the long-term adverse cardiovascular outcomes

Leilani B. B. Mercado-Asis ; Felisse Carmen Gomez-Tuazon ; Florence Rochelle Gan ; Chandy Lou Malong-Calanoc

Journal of Medicine University of Santo Tomas.2024;8(1):1390-1397. doi:10.35460/2546-1621.2024-0044

Excess hormone production from adrenal tumors caused by primary hyperaldosteronism or pheochromocytoma are common etiologies for secondary hypertension. Studies have shown that sustained long-term circulating hormones in excess affect the blood vessels and cardiac structures. Inflammation of cardiomyocytes leads to fibrosis and eventual cardiomyopathy and is clinically presented as arrhythmia, nonfatal myocardial infarction, heart failure, or even death. The tissue changes and/or impaired cardiac function are reversible if early diagnosis and removal of the adrenal tumor by unilateral adrenalectomy is done. However, the condition becomes challenging if the adrenal lesions are bilateral. This article introduces the concept of systemic hormonal unloading and will discuss the philosophy of quality of life in managing bilateral adrenal disease.
Hyperaldosteronism ; Pheochromocytoma ; Quality of Life

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The First USTFMS Department of Medicine Stethoscope Tagging Ceremony

Melvin R. Marcial

Journal of Medicine University of Santo Tomas.2024;8(1):1398-1402. doi:10.35460/2546-1621.2023-0092

It is just fitting for the oldest medical school in the Philippines, the UST Faculty of Medicine & Surgery, which just celebrated its sesquicentennial year, to initiate this trailblazing stethoscope tagging ceremony for 418 second-year medical students belonging to USTFMS Batch 2026. This activity is aligned with enhancing the Thomasian identity (one of the strategic directional areas [SDA 2] of the university) once they graduate, the Thomasian Physician identity. The stethoscope remains the symbolic representation of physician and patient care. The innovative and pivotal activity, completely different from other international medical schools’ rite of passage, was marked with meaningful symbolisms unique to USTFMS. This rite also involved a pledge to the patroness of the Department of Medicine, Mary Untier of Knots, who would thus qualify for a robust faith formation program of the university (key result area [KRA 1]). Indeed, this would be the beginning of an annual celebration of strengthening faith, hope, and charity (patient care advocacy), TRIA HAEC, the three virtues of St. Paul that comprise the core values of Thomasian education.
Schools, Medical ; Students, Medical ; Stethoscopes ; Patient Care

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A randomized controlled trial on the efficacy of ultraviolet index education on sunscreen use among patients in a tertiary hospital in Manila

Gail Josephine F. Boco ; Bernardita O. Policarpio ; Angelica I. Guzman-hernandez

Journal of Medicine University of Santo Tomas.2025;9(1):1635-1653. doi:10.35460/2546-1621.2024-0210

RATIONALE

Skin cancer is the most common cancer in fair-skinned populations. Overall, strategies focus on modifiable risk factors such as reducing ultraviolet (UV) radiation exposure through physical, topical or systemic protection. Currently, data on knowledge, attitude and practices of Filipino patients on UV index in relation to sun protection is unavailable.

OBJECTIVES

The objective of this study is to improve sunscreen use among patients seen in a tertiary hospital in Manila, specifically after UV index education.

METHODOLOGY AND POPULATION

The study will be conducted among patients at the outpatient department of the University of Santo Tomas Hospital, Department of Dermatology, after UV index education. Patients who will be included are aged 18 to 65 years old, belonging to both sexes and able to understand English or Filipino. The exclusion criteria includes children, elderly greater than the age of 65, prisoners, mentally handicapped or those with incurable diseases.

TIME FRAME

3 weeks

EXPECTED OUTCOMES

The outcome is the improvement in sunscreen use among patients seen in a tertiary hospital in Manila, specifically after UV index education.

Human ; Male ; Female ; Radiation Exposure ; Sunscreening Agents ; Dermatology

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